Article Summary
The 2027 Medicare Physician Fee Schedule proposed rule includes positive updates for radiology with a 2% overall reimbursement increase, new conversion factors effective January 1, and significant changes to the Quality Payment Program that will make MIPS Value Pathways the primary reporting framework starting in 2029.
- Conversion Factor Changes: APM participants would receive $33.1693 (down from $33.5675), while non-APM participants would get $32.8409 (down from $33.4009), reflecting statutory expiration of a 2.5% increase.
- Positive Impact Estimates: CMS projects a 2% increase for radiology and nuclear medicine, and 3% for interventional radiology and radiation oncology if finalized.
- Quality Payment Program Overhaul: MIPS Value Pathways become the primary reporting framework beginning in 2029, retiring traditional MIPS reporting.
- New Core Measures: Three diagnostic radiology measures proposed as core measures including exposure dose indices, patient exposure optimization, and appropriate follow-up imaging protocols.
- RUC Recommendations Accepted: CMS proposes accepting RUC values for fine needle aspiration, MRA of head and neck, and CT of upper extremity with new portable ultrasound equipment pricing.
The 2027 Medicare Physician Fee Schedule (MPFS) proposed rule indicates overall positive updates for radiology, according to medical imaging societies.
In its initial summary of the 2027 MPFS proposed rule, which the U.S. Centers for Medicare and Medicaid Services (CMS) issued on July 14, the American College of Radiology (ACR) noted that the rule includes proposed changes to payment provisions as well as to the Quality Payment Program (QPP).
Beginning January 1, there are two separate conversion factors resulting from the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA), according to the ACR. For 2027, the conversion factor for services provided by qualifying Advanced Alternative Payment Model (APM) participants would be $33.1693, down from the current $33.5675. The proposed rate is inclusive of a 0.75% annual update and a positive 0.53% budget neutrality adjustment, the ACR said.
The conversion factor for non-APM participants would be $32.8409, down from the current $33.4009, reflecting a 0.25% annual update and the same budget neutrality adjustment. The college noted that both conversion factors would see an aggregate decrease due to the expiration of a one-year, 2.5% conversion factor increase mandated by statute.
If finalized, CMS estimates the proposed changes would have an overall positive impact of 2% for radiology, 2% for nuclear medicine, 3% for interventional radiology, and 3% for radiation oncology, the ACR said.
For its part, the American Society for Radiation Oncology (ASTRO) said that while the estimated positive 3% impact for the specialty is welcome, the potential improvement is tempered by more cuts.
“We are particularly encouraged by proposed increases for two key radiation treatment delivery codes, but other essential services, including treatment planning and management, would still face reductions generally in the 3% to 6% range,” said Dave Adler, ASTRO’s vice president of advocacy.
The treatment delivery code improvements represent meaningful progress, but they do not resolve the underlying flaws in Medicare’s payment system that continue to create instability for radiation oncology practices and threaten patient access, Adler said.
Separately, the American Society of Clinical Oncology (ASCO) estimated that the proposed 2027 MPFS would provide a 1.5% overall reimbursement increase for radiation oncology.
“The actual impact on individual clinicians will vary based on geographic location, the mix of billed Medicare services, and whether a clinician is a [qualifying participant],” ASCO said in a statement.
The ACR noted that for the Quality Payment Program, CMS is proposing to make MIPS Value Pathways (MVPs) the primary reporting framework, retiring traditional MIPS reporting beginning with the 2029 performance period. CMS is also proposing to replace the outcome-measure reporting requirement with a requirement to report at least one MIPS "core measure." The following Diagnostic Radiology measures are proposed as core measures for 2027, according to ACR:
#145: Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy
#360: Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose Radiation Imaging Studies: CT and Cardiac Nuclear Medicine Studies
#405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions
Additionally, CMS is proposing to accept values for most radiology-pertinent codes recommended by the American Medical Association's Relative Value Scale Update Committee (RUC), including fine needle aspiration (FNA), MRA of the head and neck, and CT of the upper extremity, the ACR said. Also, the agency would create a new equipment item specific to FNA – a portable ultrasound machine priced at twice the cost of the current portable ultrasound equipment item.
The societies said that staff will review the full proposed rule in the coming weeks, provide a more comprehensive summary, and submit comments to CMS by the September 14 deadline.
